血清α1-AT、CD64感染指数、NE水平与慢性阻塞性肺疾病急性加重期患者病情程度及发生呼吸衰竭的关系OACSTPCD

Objective To explore the relationship of serum α1-antitrypsin(α1-AT),neutrophil elastase(NE),and cluster of differentiation 64(CD64)index with the disease severity and respiratory failure of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods One hundred and thirty-four patients diagnosed with AECOPD in the Department of Respiratory Medicine of the First Affiliated Hospital of Shihezi University School of Medicine from January 2021 to July 2022 were selected as the acute exacerbation group.Another 134 cases of patients with stable COPD in the hospital during the same period were included as the stable group.The serum levels of α1-AT,NE,and CD64 index,and blood gas and pulmonary function indices were compared between the two groups.The AECOPD patients were stratified according to the Simplified Acute Physiology Score Ⅱ(SAPS Ⅱ)into mild,moderate,and severe subgroups.The AECOPD patients were also analyzed based on whether they developed respiratory failure.The relationship between the occurrence of respiratory failure and the levels of α1-AT,NE,and CD64 index in AECOPD patients was deciphered using the receiver operating characteristic(ROC)curve analysis.Results The serum levels of α1-AT,NE,and CD64 index as well as PaCO2 in the acute exacerbation group were significantly higher than those in the stable group,while the forced expiratory volume in one second/forced vital capacity(FEV1/FVC),FEV1％pred,and PaO2 in the acute exacerbation group were significantly lower than those in the stable group(P＜0.05).Comparison among the mild,moderate,and severe patients demonstrated that serum levels of α1-AT,NE,and CD64 index as well as PaCO2 gradually increased with the disease severity(P＜0.05),and that FEV1/FVC,FEV1％pred,and PaO2 gradually decreased with the disease severity(P＜0.05).The serum levels of α1-AT,NE,and CD64 index as well as PaCO2 in patients with respiratory failure were significantly higher than those in patients without respiratory failure(P＜0.05),and FEV1/FVC,FEV1％pred,and PaO2 in patients with respiratory failure were significantly lower than those in patients without respiratory failure(P＜0.05).The ROC curve analysis revealed that the sensitivity of the combined detection of α1-AT,NE,and CD64 index in diagnosing respiratory failure in AECOPD patients was the highest,being 97.40％(95％CI:0.843,0.990),the specificity of SAPS Ⅱ in diagnosing respiratory failure in AECOPD patients was the highest,being 83.05％(95％CI:0.731,0.917),and that the AUC of NE in diagnosing respiratory failure in AECOPD patients was the highest,being 0.951(95％CI:0.878,0.981).Conclusion The serum levels of α1-AT,NE,and CD64 index are significantly higher in AECOPD patients than those in COPD patients,and are correlated with the disease severity.Among them,serum α1-AT and NE hold significant auxiliary diagnostic values in assessing the occurrence of respiratory failure in patients with AECOPD.